Sr. Research Analyst, Program Integrity (FWA)

Description At Commence, we’re the start of a new age of data‑centric transformation, elevating health outcomes and powering better, more efficient processes to program and patient health. We combine quality data‑driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human‑centered, healthcare‑relevant, and value‑based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care. Job Type Full‑time Requirements The Senior Program Integrity Analyst (FWA) is a senior individual contributor who brings exceptional fraud, waste, and abuse (FWA) domain expertise to Commence’s research function and translates that expertise into meaningful use cases, analyses, and insights that inform decision‑making across a range of analytic needs for federal and commercial health clients. Reporting to the Lead Research Analyst, this role anchors the function’s FWA domain coverage and leads analytic studies, evaluations, and evidence‑based briefs that surface emerging FWA trends and align with CMS, HHS and State priorities. Although FWA is the anchor domain, this analyst may also build working knowledge in adjacent areas as organizational needs evolve (e.g., broader healthcare quality and operations topics). It is a research role with a technical core. Beyond interpreting analyses, this analyst shapes the analytic approach for assigned studies and executes it hands‑on — in SQL, Python, and Databricks — carrying work from question to defensible conclusion. The ideal candidate is a recognized FWA / program‑integrity expert who has led project teams in the past but is energized by remaining hands‑on — pairing that domain depth with the technical fluency to build the analysis and the communication skill to make it land with non‑technical and federal audiences. This role also carries a guiding function: framing research questions for others, coordinating with data team members and internal operations stakeholders to scope and execute studies, and producing clear written and verbal findings. Research & Focus Studies Identify and frame FWA focus studies and use cases aligned to CMS/HHS priorities; draft clear, testable analysis plans with defined methods, data sources, and success criteria. Conduct environmental scans and literature reviews on FWA and other assigned topics, and produce evidence‑based reports and narratives tailored for CMS, client, and federal audiences. Hands‑On Analysis & Technical Execution Build and run analyses in SQL, Python, and Databricks — from data profiling through final results — and shepherd them to defensible completion that withstands client, clinical, and audit scrutiny. Ensure data validity and integrity; translate large healthcare datasets into clear dashboards, visualizations, and executive summaries. Apply FWA domain expertise throughout, encoding pattern recognition for schemes and billing anomalies into analytic logic. Guide and coordinate with other data team members and stakeholders to identify appropriate data sources and methodologies consistent with best practices in FWA research, frame analytic questions, and draft clear written findings (briefs, summaries) and deliver verbal updates to stakeholders, including non‑technical and federal audiences. Program Evaluation & Impact Design and execute mixed‑methods evaluations; develop and interpret integrity and quality indicators (e.g., improper payments, aberrant billing, appeals, timeliness, disparities). Build evaluation frameworks and logic models measuring performance, outcomes, and ROI; surface and communicate opportunities for improvement. Growth & Stakeholder Engagement Support growth and business development initiatives and proposals where program integrity is the differentiator — secondary to, and never crowding out, the core research mandate. Map work to broader CMS/HHS initiatives and partner agencies (AHRQ, CDC, NIH); collaborate with policy and communications teams on research messaging. Qualifications Bachelor’s degree in Health Policy, Public Health, Healthcare Administration, Statistics, Data Science, Economics, or a related health or quantitative field required. Expert‑level FWA / program‑integrity domain knowledge — minimum of 8 years of substantial experience in healthcare FWA (payer SIU, program‑integrity contracting, CMS/Medicaid integrity, or equivalent), sufficient to serve as the team’s domain authority. Hands‑on technical ability — strong SQL skills and working proficiency in Python; able to independently query, profile, and analyze large healthcare datasets. Applied research skill — designing analysis plans and carrying qualitative and quantitative analyses to defensible conclusions. Proven leadership as a subject‑matter expert — a track record of leading project teams or analytic workstreams, now oriented toward hands‑on delivery in this role. Healthcare systems & policy fluency — CMS frameworks, Medicare/Medicaid programs, regulatory structures, and data governance. Clear communication — synthesize and present findings to varied audiences (including clients and policymakers). Preferred Requirements Databricks / Spark experience, or a track record of ramping quickly on new tooling. Advanced degree (Master’s or PhD in a health or quantitative field); equivalent FWA experience also considered. Data visualization & standards — QuickSight, Qlik, Power BI, or Tableau; familiarity with claims data and coding systems (ICD, CPT/HCPCS, NPI). Ways of working — Agile / cross‑functional experience; prior healthcare proposal contribution. Work Environment / Physical Demands The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate‑controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch. Equal Employment Opportunity Statements Commence is an equal employment opportunity employer. All personnel processes are merit‑based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law. Commence is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at View phone number on click.appcast.io or View email address on click.appcast.io. Salary 170,000 #J-18808-Ljbffr Commence